cirrhosis complications - surgical mx
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Surgical Management of Surgical Management of Complications ofComplications of CirrhosisCirrhosis
Dr. Sanjoy Sanyal MBBS, MS
Consultant Surgeon
Victoria Hospital,
Ministry of Health, Seychelles
April 2005
Complications of Cirrhosis – 1Complications of Cirrhosis – 1
Portal HTN
Gastro-oesophageal
varicesBleeding
CongestiveSplenomegaly
(Hypersplenism)Ascites
Complications of Cirrhosis – 2Complications of Cirrhosis – 2
Cirrhosis
FulminantHepaticfailure
Hepatic(Porta-systemic)encephalopathy
UntreatedUntreated
Surgical AnatomySurgical Anatomy
Surgical Mx – Direct – Control of Surgical Mx – Direct – Control of Bleeding VaricesBleeding Varices
Ligation of varices
– Trans-thoracic
– Trans-abdominal
Surgical Mx – Direct – Control Surgical Mx – Direct – Control of Bleeding Varicesof Bleeding Varices
Transection procedures– Gastric– Oesophageal
(stapler)– Oesophageal, with
oesophago-gastric devascularization (Sugiura)
Surgical Mx – Direct – Control Surgical Mx – Direct – Control of Bleeding Varicesof Bleeding Varices
Resection of varix-bearing area – oesophago-gastrectomy
– Roux-en-Y interposition
– Jejunal interposition
– Colonic interposition
– Reversed gastric tube
Surgical Mx – Indirect – Reduction Surgical Mx – Indirect – Reduction of Portal Pressure / Flowof Portal Pressure / Flow
Porta-caval shunt
– End-to-side
– Side-to-side
– H (jump) graft
Spleno-renal shunt– End-to-end– End-to-side (proximal)– DSRS (selective;
Warren)
Surgical Mx – Indirect – Reduction Surgical Mx – Indirect – Reduction of Portal Pressure / Flowof Portal Pressure / Flow
SMV-IVC shunt (mesenterico-caval)– Side-to-side– H-graft
Coronary-caval (selective; Inokuchi)
Surgical Mx – Indirect – Reduction Surgical Mx – Indirect – Reduction of Portal Pressure / Flowof Portal Pressure / Flow
Surgical Mx – Intractable Surgical Mx – Intractable Acute BleedingAcute Bleeding
Direct – control of bleeding site
– Ligation procedure
– Transection procedure
– Resection procedureIndirect – reduction of portal pressure
– Porta-systemic shunts
Surgical Mx – MiscellaneousSurgical Mx – Miscellaneous
Hypersplenism
– SplenectomyAscites
– Peritoneo-venous shunt
–Leveen shunt
–Denver shuntHepatic failure
– Liver transplant
Thank youThank you
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